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免疫功能低下人群中不确定的干扰素-γ释放试验进展为活动性结核病的风险：系统评价和荟萃分析。

Risk of progression to active tuberculosis for indeterminate interferon-gamma release assay in immunocompromised individuals: a systematic review and meta-analysis.

机构信息

Department of Science and Research, The Affiliated Anning First People's Hospital of Kunming University of Science and Technology, Kunming, Yunnan Province, China.

Department of Immunology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.

出版信息

Clin Microbiol Infect. 2023 Nov;29(11):1375-1384. doi: 10.1016/j.cmi.2023.07.003. Epub 2023 Jul 6.

DOI:10.1016/j.cmi.2023.07.003

PMID:37422080

Abstract

BACKGROUND

Limited data exist on assessing the risk of active tuberculosis (TB) in immunocompromised individuals during screening for latent tuberculosis infection (LTBI).

OBJECTIVES

To assess the risk of progression to active TB for indeterminate interferon-γ release assays (IGRA) results in immunocompromised individuals during screening for LTBI.

DATA SOURCES

PubMed, Embase, Web of Science, and the Cochrane Library were searched without start date or language restrictions on 18 April 2023.

STUDY ELIGIBILITY CRITERIA

Cohort study or randomized controlled trials that investigated the risk of progression to active TB for indeterminate IGRA during LTBI screening.

PARTICIPANTS

Immunocompromised individuals. TEST: IGRA (T-SPOT.TB and QuantiFERON).

REFERENCE STANDARD

None.

ASSESSMENT OF RISK OF BIAS

A modified version of the Newcastle-Ottawa Scale.

METHODS OF DATA SYNTHESIS

Fixed effects meta-analysis was used to obtain two pooled risk ratios (RRs). RR-ip represented disease progression rate in untreated individuals with indeterminate IGRA versus positive IGRA. RR-in represented disease progression rate in untreated individuals with indeterminate IGRA versus negative IGRA.

RESULTS

Among the 5102 identified studies, 28 (14 792 immunocompromised individuals) were included. The pooled RR-ip and RR-in for cumulative incidence were 0.51 (95% CI, 0.32-0.82; I = 0%) and 2.94 (95% CI, 1.78-4.85; I = 0%), respectively. In addition, 11 studies reporting person-year data were included to verify the reliability of cumulative incidence results. The pooled RR-ip and RR-in for person-year incidence were 0.40 (95% CI, 0.19-0.82; I = 13%) and 2.67 (95% CI, 1.24-5.79; I = 23%), respectively.

DISCUSSION

Indeterminate IGRA results in immunocompromised individuals may represent an intermediate risk of progression to active TB, with half the risk for positive results and three times for negative results. Proper follow-up and management of patients with indeterminate results are crucial for mitigating progression risk and improving patient outcomes.

摘要

背景

在潜伏性结核感染（LTBI）筛查中，免疫功能低下个体的活动性结核（TB）风险评估数据有限。

目的

评估 LTBI 筛查中不确定的干扰素-γ释放试验（IGRA）结果的免疫功能低下个体发生活动性 TB 的进展风险。

数据来源

2023 年 4 月 18 日，无起始日期和语言限制，在 PubMed、Embase、Web of Science 和 Cochrane 图书馆中进行了检索。

研究入选标准

调查 LTBI 筛查中不确定的 IGRA 期间发生活动性 TB 进展风险的队列研究或随机对照试验。

参与者

免疫功能低下个体。

检验

IGRA（T-SPOT.TB 和 QuantiFERON）。

参考标准

无。

偏倚风险评估

纽卡斯尔-渥太华量表的改良版。

数据综合方法

采用固定效应荟萃分析获得两个合并风险比（RR）。RR-ip 代表未经治疗的不确定 IGRA 个体与阳性 IGRA 个体的疾病进展率。RR-in 代表未经治疗的不确定 IGRA 个体与阴性 IGRA 个体的疾病进展率。

结果

在 5102 项确定的研究中，纳入了 28 项研究（14792 名免疫功能低下个体）。累积发生率的合并 RR-ip 和 RR-in 分别为 0.51（95%CI，0.32-0.82；I=0%）和 2.94（95%CI，1.78-4.85；I=0%）。此外，纳入了 11 项报告人年数据的研究，以验证累积发生率结果的可靠性。人年发生率的合并 RR-ip 和 RR-in 分别为 0.40（95%CI，0.19-0.82；I=13%）和 2.67（95%CI，1.24-5.79；I=23%）。